What is the clinical significance of a paradoxical decrease in HDL cholesterol after starting statin therapy?  

Whether HDL goes up, goes down or stay stable on statin therapy is honestly not of much concern to me. I do not think it is of any clinical significance since we know that statin therapy improves outcomes. In fact, studies show that the clinical benefit of statins is even stronger in individuals wit...

I agree that the modest/minimal changes in HDL upon starting statin Rx are likely clinically meaningless. During the "statin-wars" that were all we heard about from different pharma sources, but it is probably related to a large drop in total cholesterol flux through the circulation - maybe CETP is ...